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GENOA HEALTHCARE LLC
CH06657B LA ESPERANZA CLINIC, INC.
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Covered Entity Details
Entity Name
LA ESPERANZA CLINIC, INC.
Subdivision Name
La Esperanza's Health and Dental Centers North Clinic
Type
HRSA-Funded Health Center
340B ID
CH06657B
Entity Address
35 East 31st St
San Angelo, TX 76903-2207
Grant Number
H80CS00203
Participating Start Date
9/12/2008
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
GENOA HEALTHCARE LLC
Pharmacy Address
35 E 31ST ST STE A
SAN ANGELO, TX 76903
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
10/25/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dean Munn, CEO
(325) 947-5600
Contract Pharmacy Representative
Genoa Pharmacy
Esther Chen, Pharmacist
(325) 716-4930
Signed By Date
10/17/2022
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